Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria

Onwujekwe, Obinna; Dike, Nkem; Uzochukwu, Benjamin; Ezeoke, Ogochukwu P

doi:10.1016/j.healthpol.2009.12.014

Cited by 41 publications

(63 citation statements)

References 25 publications

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“…The low number of households having declared informal costs would clearly generate an underestimation of treatment costs incurred by households. Previous studies have shown that, when considering informal payments, the global expenditures of treating malaria can be three times higher than the costs declared by healthcare providers [27,33,34].…”

Section: Limitations Of the Studymentioning

confidence: 97%

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo

Ilunga-Ilunga

Lévêque

Ngongo

et al. 2014

J Infect Dev Ctries

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Introduction: Malaria remains a real problem of public health. Its hospital care generates important expenditures for affected households. The present study aimed to estimate direct and indirect costs of severe child malaria in reference hospitals in Kinshasa. Methodology: This prospective study included 1,350 children under 15 years of age suffering from severe malaria. The study was performed between 1 January and 30 November, 2011. Data were collected in nine reference hospitals. The studied parameters were direct pre-hospital costs, direct hospital costs, and indirect costs. Costs were assessed from the household point of view. Results: Median costs associated with the disease ranged from 114 USD in confessional hospitals to 173 USD in state hospitals and 308 USD in private hospitals. Direct pre-hospital median costs ranged between 3 and 11 USD. Direct hospital costs reached 72 USD in confessional hospitals, 139 USD in state hospitals, and 254 USD in private hospitals. Indirect costs ranged from 22 USD in state hospitals to 30 USD in confessional hospitals and 46 USD in private hospitals, regardless of the status of the accompanying parent or guardian. Factors explaining the variability of costs were the neurological form of malaria, indirect recourse to hospital, socioeconomic level, type of prescribing person, child's status upon leaving the hospital, and child's transfusion status. Conclusions: The care of severe child malaria appeared to be expensive in private and state hospitals. A state subsidy of health care and regulation of the private sector would contribute to the reduction of malaria's financial impact.

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Section: Limitations Of the Studymentioning

confidence: 97%

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo

Ilunga-Ilunga

Lévêque

Ngongo

et al. 2014

J Infect Dev Ctries

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show abstract

“…This can be explained in part by inflation, technological advancement and epidemiological transitions, but it is also due to an increase in the practice of informal charges being demanded by physicians (1). Informal payments; the money paid to doctors for services outside of the framework of formal tariffs (2), or charges which patients pay in addition to the formal tariffs, are a widespread phenomenon (1). These payments are one of the many coping strategies adopted by medical staff and patients, in countries where health systems are underfunded, overstaffed, and burdened with broad mandates promising free access to care (3).…”

Section: Introductionmentioning

confidence: 99%

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

Nekoei‐Moghadam

Esfandiari

Ramezani

et al. 2013

Int J Health Policy Manag

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Background: Informal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. Many countries are putting reforms in place with the aim of reducing informal payments. In order to be successful, such policies should be informed by the underlying causes of such payments. This study attempts to explore why, how, and in what ways informal payments occur. Methods: We conducted face-to-face interviews with a purposeful sample of 45 participants, including patients, healthcare providers and officials, in Kerman province in Iran, in 2010. The research participants were asked about the nature of informal payments, the reasons behind both asking and making those payments. We analysed the data using content analysis. Results: We found that people make informal payments for several reasons, namely cultural, qualityrelated and legal. Providers ask for informal payments because of tariffs, structural and moral reasons, and to demonstrate their competence. Informal payments were found to be more prevalent for complex procedures and are usually asked for directly. Conclusion:Informal payments are present in Iran's health system as in other countries. What makes Iran's condition slightly different from other countries is the peculiarity of reasons behind asking informal payments and the disadvantages associated with these kinds of payments. Iran could overcome this dilemma by precise investigation of the reasons to inform appropriate policy formulation. Some policies such as raising salaries, justifying the tariffs and cost-sharing, defining a benefits package of services, and improving accountability and transparency in the health system could be taken by the government to alleviate the problem.

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“…In Nigeria, Onwujekwe et al (2010) find that 65% of the expenditure for malaria treatment reported by consumers was not reported by providers. Of particular interest in this paper is that such differences were not confined to public facilities, suggesting that health workers in the private sector may also charge sums beyond those reported to employing institutions, and that the return to employment in private facilities may not be wholly captured by the official salary there too.…”

Section: Health Workers Charging Patients Directly For Services: Pricmentioning

confidence: 95%

“…Gaal, Evetovits, and McKee (2006); Onwujekwe et al (2010);and Hunt (2010) analyze the processes of informal payments in Hungary, Nigeria, and Uganda, respectively. Gaal, Evetovits, and McKee (2006) estimate informal payments in Hungary at 1.5-4.6% of total health expenditure, suggesting a minor role as a source of finance.…”

Section: Health Workers Charging Patients Directly For Services: Pricmentioning

confidence: 99%

Analyzing Markets for Health Workers: Insights from Labor and Health Economics

McPake¹,

Scott²,

Edoka³

2014

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Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria

Cited by 41 publications

References 25 publications

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo

Costs of treatment of children affected by severe malaria in reference hospitals of Kinshasa, Democratic Republic of Congo

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

Analyzing Markets for Health Workers: Insights from Labor and Health Economics

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